Rimek Dagmar, Redetzke Kristin, Kappe R
Abteilung für Medizinische Mikrobiologie und Krankenhaushygiene, Universität Rostock, Rostock, Germany.
Mycoses. 2006;49 Suppl 2:18-23. doi: 10.1111/j.1439-0507.2006.01319.x.
Patients with haematological malignancies are at high risk for developing invasive Candida infections. They are often colonised with Candida spp. in the gastrointestinal (GI) tract. In order to prevent infection, the prophylactic use of antifungal agents has been established. The widespread use of fluconazole may lead to the emergence of resistant Candida isolates. We studied the yeast colonisation of the GI tract in patients with haematological malignancies receiving antifungal prophylaxis (AP) in comparison with healthy controls. The study cohort included 46 neutropenic patients with 52 stool samples under 52 episodes of AP and 110 healthy controls. The patients received amphotericin B orally (n = 8), amphotericin B and fluconazole (n = 7), amphotericin B and itraconazole (n = 5), fluconazole orally (n = 15) and itraconazole orally (n = 17). Yeasts were cultured from the stool samples of 63.5% of the patients and 60% of the controls with a mean yeast load of 1.6 x 10(3) and 0.4 x 10(3) cfu g(-1), respectively (P = 0.045). Patients and controls had a low faecal yeast load of 10(3) to 10(4) cfu g(-1) in 19.3% and 37.3%, respectively (P = 0.021), and yeast overgrowth of >10(5) cfu g(-1) in 28.9% and 10.9%, respectively (P = 0.004). The rate of Candida albicans was 32.6% and 54.1% in the patients and controls, respectively (P = 0.021). The rates of fluconazole-resistant yeast species were higher in the patient group than in the control group: C. glabrata 20.9% vs. 11.7% (P = 0.168), C. krusei 25.6% vs. 4.7% (P = 0.001). Not a single patient under AP suffered from proven or probable invasive candidosis. In conclusion, oral AP in haematological patients resulted in a higher colonisation rate with fluconazole-resistant Candida species but efficiently prevented invasive candidosis.
血液系统恶性肿瘤患者发生侵袭性念珠菌感染的风险很高。他们的胃肠道（GI）常被念珠菌属定植。为预防感染，已确立了抗真菌药物的预防性使用。氟康唑的广泛使用可能导致耐药念珠菌分离株的出现。我们研究了接受抗真菌预防（AP）的血液系统恶性肿瘤患者与健康对照者胃肠道的酵母菌定植情况。研究队列包括46例中性粒细胞减少患者，在52次AP期间采集了52份粪便样本，以及110名健康对照者。患者接受口服两性霉素B（n = 8）、两性霉素B和氟康唑（n = 7）、两性霉素B和伊曲康唑（n = 5）、口服氟康唑（n = 15）和口服伊曲康唑（n = 17）。分别从63.5%的患者和60%的对照者的粪便样本中培养出酵母菌，平均酵母菌载量分别为1.6×10³和0.4×10³ cfu g⁻¹（P = 0.045）。患者和对照者粪便酵母菌载量低（10³至10⁴ cfu g⁻¹）的比例分别为19.3%和37.3%（P = 0.021）；酵母菌过度生长（>10⁵ cfu g⁻¹）的比例分别为28.9%和10.9%（P = 0.004）。白色念珠菌的比例在患者和对照者中分别为32.6%和54.1%（P = 0.021）。患者组中耐氟康唑酵母菌种类的比例高于对照组：光滑念珠菌为20.9%对11.7%（P = 0.168），克柔念珠菌为25.6%对4.7%（P = 0.001）。接受AP的患者中没有一例发生确诊或可能的侵袭性念珠菌病。总之，血液系统疾病患者口服AP导致耐氟康唑念珠菌种类的定植率更高，但有效预防了侵袭性念珠菌病。
